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Don’t trust advice from pharmacists

15/08/2013

I recently picked up some prescription medication from a local pharmacy. The pharmacist on duty insisted on advising me as to the safe way to use the substance so as to minimise one of its most common and serious side-effects. The advice was accurate and probably would have been useful were it not for the fact that it was common sense, written on the packet, written on the enclosed safety leaflet, written on the instruction sheet I had received from the hospital that prescribed it to me and explained to me over the phone by a hospital representative. But it would have been pretty churlish of me if I had resented receiving that advice again – the consequences of not following it are potentially severe – so I was content to stand there and hear it.

But I would never rely on a pharmacist for any kind of medical advice whatsoever, despite the fact that they have received more medical training than have I. Why? Because they are riddled with conflicts of interest. They are not doctors, they are shopkeepers.

When I lived in Ashfield a local pharmacist used a database of all nearby people who had purchased asthma medication from him to send personal letters inviting us to attend an asthma education lecture at the local town hall. His presentation was friendly, slick, easy to comprehend and mostly accurate – though some of the information he gave was somewhat dated and no longer corresponded to best practice asthma management – but only took up half the time allotted to the meeting. The other half was devoted to a representative from a medical device company he had invited to demonstrate and try to sell his wares to us. At least one of those devices had been superceded almost a decade earlier by technology the pharmacist had failed to mention during his lecture.

I don’t know if he received kickbacks from the company that manufactured the devices. I don’t know if he cynically misinformed us about up-to-date asthma management to help the sales rep sell his dated products. But I do know I was very uncomfortable about having my private medical information accessed by him at all, much less for reasons that were at least partially aimed at selling me something.

When I contacted the Pharmacy Guild to lodge a complaint they were completely uninterested and insisted the pharmacist had done nothing unethical.

However this incident alone is not why I would not take medical advice from a pharmacist.

I often purchase multiple asthma inhalers at a time. I like to have one at my bedside, one at my workplace and one in my backpack. It’s not good to be caught without an inhaler during an asthma attack.

On four occasions pharmacists have refused to fill my prescription for more than one inhaler at a time, insisting loudly and within earshot of other customers that inhalers are addictive, prone to recreational use or illegally on-sold to children. None of those things are true. In one case one of the other customers happened to be a doctor, who took the pharmacist to task for giving false information and insisted that he fill my prescription in full, which he did. In the others I retreated humiliated under the gaze of disapproving customers and purchased my inhalers elsewhere.

People with dark skin or who ‘look like a druggie’ – like me for instance – can find it pretty difficult to fill a prescription for painkillers too.

Pharmacists have been known to berate women seeking contraceptives that conflict with their religious convictions.

Surveys have repeatedly shown that pharmacists routinely give inadequate advice to their customers.

In 2008 the UK consumer magazine ‘Which?’ found that a third of UK pharmacists gave incorrect or misleading answers to at least one of three fairly basic questions about their products. Customers who followed such advice would have been at risk of taking wrong medication for migraine, missing a serious bowel infection or contracting a sexually transmitted disease. The Australian equivalent to ‘Which?’, ‘Choice’ magazine, recently discovered that pharmacists are recommending pregnant women take herbal and alternative treatments that risk harming their unborn child but many fail to give important advice about iodine and other supplements. Iodine offers much smaller profit margins than do most herbal medicines. In a similar vein, ‘Pharmacy News’ reports pharmacists’ knowledge of which medications can be safely used by breastfeeding mothers is ‘poor’. Infant formulas provide a steady income stream to most Australian pharmacies.

A Melbourne pharmacist recently sold strychnine to a man who wanted something to put on his son’s fingertips to stop him biting his nails. If used it would certainly have stopped him. Stopped him dead.

If you walk into any pharmacy in Australia you will see a large range of products prominently displayed that are of no medical value or potentially harmful. I’m not just talking about cosmetics and hair care products. Most of the nutritional supplements, arthritis treatments and diet programs that are the bread and butter of the pharmacy business have been repeatedly shown to be ineffective or, in a few cases, actively harmful. I have seen pharmacies around Newcastle promoting herbalists, naturopaths, iridologists and chiropractors. I have also seen highly inappropriate marketing campaigns for over the counter medicines, such as carry bag giveaways for buying multiple boxes of anti-diarrhea pills that work by paralysing the large intestine.

Pharmacists often enter into promotional agreements with companies that sell products of dubious medical value.

In 2011 the Pharmacy Guild of Australia was forced to back down after widespread condemnation of a deal it had made to use its computer network to prompt pharmacists to offer Blackmores’ supplements to patients filling prescriptions for certain kinds of medicines. Bioceuticals and MyGene have recently teamed up with a large number of individual pharmacists to market expensive and unproven genetic tests that will supposedly match customers to specific supplements they manufacture.

There are certainly problems with the medical knowledge of many GPs. They do not have time to read all the journals and keep up to date with current medical research. Increasingly they are getting their continuing medical education from drug company representatives, which is why there is so much unsafe prescribing that flies in the face of clinical evidence, such as antidepressants for people with bipolar disorder. But unlike pharmacists, few doctors draw a large proportion of their income from unproven or fraudulent therapies.

You would not take advice about motor vehicles from a car salesman with a lot full of lemons.
You would not seek nutritional information from a McDonalds manager.
Don’t trust medical advice from snake-oil salesmen.

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Postscript (01 March, 2017): Choice recently sent mystery shoppers to 240 Australian pharmacies to seek advice about dealing with stress. While almost half the pharmacists advised seeing a doctor fewer than 30% recommended the relaxation techniques, cognitive behavioral therapy or changes in diet, exercise and lifestyle that are considered the gold standard in treating stress. About a third recommended alternative medicines such as homeopathy, Bach flowers, Valerian or St John’s Wort that have no evidence base for stress management. A further 46% recommended vitamin supplements that are unlikely to be more effective than a placebo. 85% gave incorrect assurances that the recommended product(s) would work with 24% falsely claiming it was scientifically proven (18% told the mystery shopper Bach flowers had been shown to work by science). 97% gave advice which, if followed, would have resulted in financial benefit to the pharmacy. Some even attempted to sell Metacalm – a supplement with no evidence base or safety data and which can’t be legally sold in Australia. This is consistent with earlier Choice investigations revealing Australian pharmacists promoting and selling quack remedies to consumers.

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From → autobiography

6 Comments
  1. This x100. I have had to switch chemists after my usual pharmacist fucked up my prescription TWICE (first time they gave me the wrong pills, second time they gave me half as much as I should have gotten. ) I also had to suffer the lecture about side effects even though I’d heard and read it a million times, and the same speech was in fact included in printed form along with my pills.

    There’s not much to admire about the US system of prescription healthcare, but at least I didn’t need to shell out for a doctor’s visit every time I needed a prescription renewal. My doctor was able to call the chemist, tell them his DEA prescribing code, and lodge a prescription on my behalf. SO much easier.

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  2. And don’t even get me started on the quackery. Pharmacies that sell worthless diet pills and homeopathy (I.e. sugar) are beneath comtempt. I don’t mind stocking up on nail polish and razors while I’m getting a script filled, but homeopathy? That is just irresponsible.

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  3. Mike permalink

    Stereotyping an entire profession demonstrates a deficit in the character of the author. All professions have their lemons- just as many bloggers are quacks.

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    • Yes, but some professions have inbuilt structural biases that attract, encourage and empower the lemons at the expense of those who aspire to be ethical and responsible. Where are the ‘concerned pharmacists’ speaking out about all the useless and harmful rubbish that fills the shelves at any community pharmacy you walk into? I’m sure you can find some in the dark corners at pharmacists’ conventions but how are the general public supposed to find the apparently silent minority more concerned with medicine than making money?

      Ad hom shooting at the messenger is aimed at entrenching such dysfunction and leaving us with the sort of community pharmacy network we see today. However this seems SOP in the pharmacy industry, as demonstrated by the attacks made by the Pharmacy Guild on media outlets who reported their secret deal with Blackmores. Do you suppose they have something to hide?

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  4. Mike permalink

    There is a review of pharmacy remuneration and regulation currently underway. The review is taking a community benefit approach and is receiving submissions and suggestions from all stakeholders including members of the public. Intelligent submissions may gain traction.

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    • Yes, I’m aware of that, thanks to Dr Justin Coleman’s excellent blogpost, and I thank you for drawing attention to it here. For some reason it has had very little media coverage, despite being of vital public importance in my view.

      Call me a pessimist, but I seriously doubt it will have any impact though. It seems to me the entire business model of community pharmacies needs to be torn down and rebuilt from the ground up and that would leave most current pharmacy owners running in mid-air like Wile E Coyote. I can’t see anything so radical coming out of such a review even if there weren’t such well resourced vested interests ready to sabotage any real attempt at reform. I think the best outcome we could possibly hope for from this review would be a ban on direct-to-consumer marketing by pharmacies – as is currently the case with drug companies in every first world country except the US and NZ – and even that seems very unlikely to me. If you don’t think such marketing is a problem I invite you to look at the next piece of pharmacy junk mail you receive and compare the claims it makes with their evidence base.

      However if the general public stops seeing pharmacists as medical professionals and starts to treat them as the for-profit retailers they really are I think a lot of the medical harm and waste of money promoted by pharmacists will be mitigated. So in the meantime I’ll continue to sing my song. Don’t Trust Medical Advice From Pharmacists.

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